Optimizing Antimicrobial Drug Use in Surgery: An Intervention Strategy in A Sudanese Hospital to Combat The Emergence of Bacterial Resistant

Background: Antimicrobial control programs are widely used to decrease antibiotic utilization, but effects on antimicrobial resistance and outcomes for patients remain controversial. The purpose of this study was to determine the impact of rotation of antibiotic classes used as empirical surgical prophylaxis on the emergence of bacterial resistance organisms and antibiotics drug use when compared with non-rotation period. Method: Three core, broad spectrum agents (cephalosporins, beta-lactam-inhibitors, and fluoroquinolones) were selected for inclusion in the quaternary rotation for 21 months, based on prior 8 months baseline data from GIT and urology surgical wards in Ibn Sina hospital. Intensive surveillance done for patients admitted to the selected settings. Results: 1681 surveillance samples obtained from 2359 eligible inpatients admitted to hospital from Jan 2008 to May 2010. A significant reduction in the percentage of positive growth had been observed with antibiotic rotation for both wards from 65% and 49% in baseline to 59% and 33% in rotation (1) and 25% and 33% in rotation (2) in GIT and urology ward respectively (p< 0.0001). As general there was a divergent effect of the antimicrobial rotation on the prevalence of resistance among G+ve and G-ve bacteria. Conclusion: We concluded that antimicrobial drug use in surgical departments could be optimized after implementation of antimicrobial cycling policy, and associated in reduction in the incidence of infectious mortality and morbidity but stabilize antibiotic resistance, without significant reduction.